Developing, Implementing, and Pilot Testing an Informed Decision Aid for Opioid Agonist Therapies for Prisoners in Ukraine

项目摘要/摘要 东欧和中亚(EECA)地区的艾滋病毒增长最快 在世界范围内流行，再加上高监禁和注射毒品的比率。那些 注射毒品(PWID)集中在监狱，这是一个吸毒率最高的地区 监禁，70%的残疾人经历终身监禁，36%的人经历 每年一次的监狱。美沙酮或丁丙诺啡的阿片激动剂疗法(OAT)是证据- 基于实践(EBP)，有效地将PWID中艾滋病毒和丙型肝炎的传播减少54%，以及 分别减少61%，并将死亡率降低3倍。一名由38名囚犯组成的OAT试点从乌克兰开始 2020年的监狱，但EECA和建模数据显示，监狱的覆盖率和规模都很低 乌克兰建议，不仅必须显著增加监狱的覆盖率，而且必须 发布后仍保留在上面。然而，监狱环境会影响有关燕麦片的决定 由于监狱内部的背景因素，以及对监禁就是治疗的误解。 知情决策辅助工具是基于证据的工具，可以促进OAT的执行 以及在监狱中扩大规模，因为他们指导PWID决定是否采用OAT以及采用什么 根据个人喜好进行选择。这项拟议的研究试图理解 乌克兰被监禁的PWID的治疗偏好，采用知情的决策援助 针对这些首选项和上下文，试行测试该辅助工具，并构建一个数学模型，说明如何 扩大援助规模将在10年内影响艾滋病毒和丙型肝炎病毒的传播。我建议： 1)对600名使用阿片类药物的囚犯进行联合选择和分段分析 了解乌克兰阿片类药物使用障碍囚犯的燕麦偏好。 这些调查结果将指导我将在哪里调整知情决策援助2) 系统地调整现有的阿片类药物使用障碍的知情决策辅助工具 通过阿尔法和贝塔测试与囚犯的适应互动原型的乌克兰监狱环境 (n=25)和提供者(n=10)，并评估这一实施工具在改变 使用设计前/设计后试点研究(n=100)作出关于燕麦片的决定；以及3)评估有效性 这种知情的决策援助，以扩大监狱中的燕麦片及其假设的影响 在乌克兰PWID中，使用基于马尔可夫的方法，在10年范围内传播艾滋病毒和丙型肝炎病毒 动态状态转换模型。这些发现，如果知情的决策辅助影响 OAT扩展，可用于指导在整个东部地区采用此实施战略 欧洲和中亚的监狱，由于监狱的残迹而具有类似的结构 前苏联的体制。

Project Summary/Abstract The Eastern European and Central Asian (EECA) region has the most rapidly growing HIV epidemic world-wide, compounded by high rates of incarceration and drug injection. People who inject drugs (PWID) are concentrated in prisons, a region with some of the highest rates of incarceration, where 70% of PWID experience lifetime incarceration and 36% pass through prisons annually. Opioid agonist therapies (OAT) with methadone or buprenorphine are evidence- based practices (EBPs) that effectively reduce HIV and HCV transmission in PWID by 54% and 61%, respectively, and reduce death 3-fold. An OAT pilot of 38 prisoners started in Ukrainian prisons in 2020, yet coverage and scale-up in prisons is low in EECA and modeling data from Ukraine suggests that not only must coverage markedly increase in prisons, but PWID must be retained on it post-release. The prison environment, however, influences decisions about OAT due to within-prison contextual factors alongside misperceptions that incarceration is treatment. Informed decision-making aids are evidence-based tools that may facilitate OAT implementation and scale-up in prisons as they guide PWID in deciding whether or not to adopt OAT and what to choose based on personal preferences. The proposed research seeks to understand the treatment preferences of incarcerated PWID in Ukraine, adapt an informed decision-making aid to these preferences and context, pilot test this aid, and build a mathematical model showing how scale-up of the aid would impact HIV and HCV transmission over a 10-year horizon. I propose to: 1) Use conjoint-based choice with segmentation analysis with 600 prisoners with opioid use disorder to understand the OAT preferences of prisoners with opioid use disorder in Ukraine. These findings will guide adaptation of the informed decision-making aid where I will 2) systematically adapt an existing informed decision-making aid for opioid use disorder to the Ukrainian prison context by alpha and beta testing the adapted interactive protype with prisoners (n=25) and providers (n=10), and assess the utility of this implementation tool in changing decisions about OAT using a pre/post design pilot study (n=100); and 3) assess the effectiveness of this informed decision-making aid to scale-up OAT in prisons and its hypothetical impact on HIV and HCV transmission over a 10-year horizon in PWID in Ukraine, using a Markov-based dynamic state-transition model. These findings, if the informed decision-making aid influences OAT scale-up, can be used to guide adoption of this implementation strategy throughout Eastern European and Central Asian prisons, which have similar structures due to vestiges of the prison system of the former Soviet Union.